Comorbidities, mental health issues worsen quality of life in pediatric type 1 diabetes

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Children and teens with type 1 diabetes and two or more comorbidities or a mental health condition have a worse health-related quality of life compared with those with no comorbidities, according to a study published in Diabetic Medicine.

“In this relatively large sample of more than 600 pediatric and adolescent youth with type 1 diabetes, aged 5 to 18 years, general health-related quality of life is fairly well preserved unless the youth are confronted with multiple other health conditions or with mental health problems,” Lori Laffel, MD, MPH, chief of the pediatric, adolescent and young adult section and head senior investigator of the section on clinical, behavioral and outcomes research at Joslin Diabetes Center, and professor of pediatrics at Harvard Medical School, told Healio. “It is important for pediatric diabetes health care teams to be aware of other health conditions and/or the presence of mental health concerns in youth with type 1 diabetes who are under their care to provide timely support to these youth and their families along with referrals to mental health experts.”



Laffel is chief of the pediatric, adolescent and young adult section and head senior investigator of the section on clinical, behavioral and outcomes research at Joslin Diabetes Center, and professor of pediatrics at Harvard Medical School.

Laffel and colleagues conducted a cross-sectional analysis of data from four studies evaluating health-related quality of life in 601 pediatric patients with type 1 diabetes aged 5 to 18 years and their parents. All participants had diabetes for at least 6 months and received a minimum daily insulin dose of 0.5 U/kg. Youths and parents completed the Pediatric Quality of Life Inventory. Sociodemographic, biomedical and diabetes-specific data were collected through self-report, interviews and electronic medical records.

Of the study cohort, 338 had no comorbidities, 157 had one comorbidity and 106 had two or more comorbidities. The most frequently reported comorbidities were seasonal allergies (11%), asthma (10%), hypothyroidism (7%), ADHD (5%), skin problems (5%) and celiac disease (4%). Of the study cohort, 10% reported a mental health condition.

“The care of type 1 diabetes is exceptionally demanding, so the added burden of other conditions in such a large proportion of youth underscores the need to assess quality of life and well-being of these young people with type 1 diabetes and provide support as needed,” Laffel said.

After adjusting for covariates, youths with two or more comorbidities were more likely to report a lower health-related quality of life score compared with those with no comorbidities (beta = –7.6; P < .0001) and one comorbidity (beta = –6.6; P = .0002). Youths with more comorbidities who received injection-based therapy were also more likely to have worse health-related quality of life (beta = –3.1; P = .009).

Autoimmune, gastrointestinal, cardiovascular, neurologic and respiratory comorbidities were not associated with health-related quality of life. In multivariable models predicting health-related quality of life, having a mental health condition (beta = –6.7; P = .001) and two or more comorbidities (beta = –5.6; P = .0005) were associated with a lower health-related quality of life. In models predicting parent proxy-reported quality of life, the presence of a mental health condition (beta = –8.7; P < .0001), two or more comorbidities (beta = –5.9; P < .0001) and injection-based therapy (beta = –3.1; P = .009) were associated with a lower health-related quality of life.

Laffel said future research can focus on the best ways for screening for mental health conditions and strategies to provide mental health support for youths and their families.

For more information:

Lori Laffel, MD, MPH, can be reached at [email protected]

Janelle B. Smith

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